HbA1c-defined dysglycemia among rural Bangladeshi adolescents: a population-based cross-sectional study

Background Whereas dysglycemia among adolescents without overweight/obesity was reported in an urban hospital in Bangladesh during 2001–2002, rural epidemiological studies using fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) identified only type 1 and type 2 diabetes, with increased BMI reported as a risk factor. Thus, we aimed to determine the prevalence of dysglycemia and its association with body mass index-for-age z-score (BAZ) among adolescents in rural Bangladesh during a rapid nutritional transition. Methods A population-based cross-sectional study was conducted from December 2017 to March 2018 in the Matlab Health and Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) using a random sampling technique to recruit adolescents aged 10–19 years. A total of 291 adolescents underwent anthropometry and measurement of FPG and glycated hemoglobin (HbA1c). OGTT was performed on those with elevated FPG, elevated HbA1c, and/or positive postprandial glycosuria. Dysglycemia was defined according to the American Diabetes Association criteria of diabetes and prediabetes. Comparisons between adolescents with and without dysglycemia were performed using the Student’s t-test and the Mann–Whitney U test. Crude and adjusted odds ratios (cORs, aORs) for dysglycemia were calculated. Results Dysglycemia was detected in 43 of 291 adolescents(14.8%; 95% CI 10.7–18.8%), with 68% of affected males aged ≤ 14 years. The median BAZ of the study population was −0.8. Risk for dysglycemia was associated with a family history of diabetes (aOR: 3.00; 95% CI 1.23 – 7.04; p = 0.017). Although overweight/obesity was more prevalent among adolescents with dysglycemia than among those without (16% vs 7%; p = 0.064), most adolescents with dysglycemia did not have overweight/obesity (36/43, 84%). HbA1c detected 36 of the 43 cases (84%), while no cases were identified by OGTT alone under the stepwise screening protocol, suggesting that screening strategies focused on FPG or overweight/obesity may fail to identify adolescents with dysglycemia in this population. Conclusions HbA1c-defined dysglycemia was present among rural Bangladeshi adolescents and was not confined to overweight/obesity. These findings suggest that screening strategies based primarily on overweight/obesity may overlook at-risk individuals with low-to-normal BAZ.